Talk Title: Every breath we take: the lifelong impact of air pollution Routes to Clean Air is a two-day conference from the IAQM where academics, professionals and policy makers share their experiences of improving traffic emissions. This event highlights the importance of public communication and behavioural change surrounding road transport and air quality issues.

1. Professor Stephen Holgate
MRC Clinical Professor,
University of Southampton
Every breath we take: the
lifelong impact of air
pollution
Air pollution through the lifecourse

2. The Great Smog of 1952 took hold on London 64
years ago, claiming an estimated 4200 lives.

3. How the report came about
• Great strides made on tobacco
control, alcohol and obesity
• Air pollution remains a major public
health challenge
• RCP and RCPCH convened working
party to discuss evidence and draw up
recommendations

4. Why the RCP is tackling this issue
• Air pollution estimated to cause
around 40,000 deaths per year in
the UK
• Estimated cost of air pollution is
£20bn annually in the UK
• Linked to major health challenges
of our day such as heart disease,
asthma, COPD, lung cancer,
diabetes and dementia

5. Diseases, conditions and biomarkers affected by
outdoor pollution. Conditions currently included in the Global
Burden of Disease categories shown in bold.

6. Air pollution in our changing world
• Changes in the way we live
have changed air we breathe
• Total distance walked each
year decreased by 30%
between 1995 and 2013
• In 2012, road traffic in the UK
was 10x higher than in 1949
• Not just outdoor environment
but indoor as well

7. Annual distance travelled by road in the UK
Now, 774,513 diesel
cars in London
170,000 (30%)
increase since 2012

8. Health effects of pollutants
across 24 hours/day
of exposures

9. Protecting future generations
• First report to examine health
implications of exposure to air
pollution over lifetime
• Developing heart, lung, brain,
hormone systems and immunity
can all be harmed by pollution
• Effects growth, intelligence,
asthma and development of the
brain and coordination

10. Critical periods of risk from pollution during
fetal development

11. Principle stages of lung development
in humans

12. Effect of air pollution in modifying gene expression
- epigenetics

13. Health effects of air pollution over
our lifetime

14. Vulnerable groups
Some people suffer more from exposure to air
pollution because they are:
• More likely to live in polluted areas
• Exposed to higher levels of air pollution
• More vulnerable to health problems caused by air
pollution

15. Recommendations for action
1. Act now, think long term. We must act now, and with urgency, to
protect the health, wellbeing and economic sustainability of today’s
communities and future generations. Government must empower
local authorities and incentivise industry to plan for the long term.
2. Educate professionals and the public. The NHS and patient charities
must educate health professionals, policymakers and the public
about the serious harm that air pollution can cause. Health
professionals, in particular, have a duty to inform their patients.

16. 3) Promote alternatives to cars fuelled by petrol and diesel. Government,
employers and schools should encourage and facilitate the use of public
transport and active travel options like walking and cycling. Active travel
also increases physical activity, which will have major health benefits for
everyone. Local Transport Plans, especially in deprived areas, should:
• expand cycle networks
• require cycle training at school,
• promote safe alternatives to the “school run”, based on walking,
public transport and cycling instead of cars
• encourage employers to support alternatives to commuting by car
• promote leisure cycling
• develop ‘islands’ of space away from traffic, for safer walking and
cycling.
European, national and local policies should also encourage the use
of electrical and hydrogen-powered vehicles.

17. 4. Put the onus on the polluters. Polluters must be required to take
responsibility for harming our health. Political leaders at a local, national
and EU level must introduce tougher regulations, including reliable
emissions testing for cars. They must also enforce regulations vigorously,
especially in deprived areas where pollution levels are higher and people
are more vulnerable.
5. Monitor air pollution effectively. Air pollution monitoring by central and
local government must track exposure to harmful pollutants in major
urban areas and near schools. These results should be proactively
communicated to the public, in a clear way that everyone can understand.
When levels exceed EU limits or World Health Organization guidelines,
local authorities must immediately publish serious incident alerts.

18. 6. Act to protect the public health when air pollution levels are high.
When these limits are exceeded, local authorities must have the power
to close or divert roads to reduce the volume of traffic, especially near
schools.
7. Tackle inequality. Our most deprived communities are exposed to
some of the worst outdoor and indoor air quality, contributing to the
gap in life expectancy of nearly 10 years between the most and the
least affluent communities. Regulators, local government and NHS
organisations must prioritise improvements in air quality in our most
deprived areas, setting high standards of emission control across all
sectors of industry.

19. 8. Protect those most at risk. Children, older people, and people with
chronic health problems are among the most vulnerable to air pollution.
Public services must take account of this disproportionate harm through
local tools such as planning policies for housing and schools, equalities
impact assessments, and joint strategic needs assessments. At an
individual level, healthcare professionals should help vulnerable patients
protect themselves from the worst effects of air pollution.

20. Information packs developed as part of the Barts Health
Cleaner Air Programme developed by the Global Action Plan
9. Lead by example in the NHS. The NHS is one of the largest employers in
Europe, contributing 8% of the UK’s gross domestic product (GDP). The
health service must no longer be a major polluter; it must lead by example
and set the benchmark for clean air and safe workplaces. In turn, this
action will reduce the burden of air pollution-related illness on the NHS.
The Department of Health, NHS England and the devolved administrations
must give commissioners and providers incentives to reduce their
emissions, and protect their employees and patients from dangerous
pollutants.

21. What can I do?
As citizens and members of the public, everyone can help by:
• trying alternatives to car travel: bus, train, walking and cycling
• aiming for energy efficiency in our homes
• keeping gas appliances and solid fuel burners in good repair
• asking our local council and MPs to take action
• learning more about air quality and staying informed.
It might seem as if individual actions will not make a difference, but it all
adds up, and each one of us must act.

22. 10.Define the economic impact of air pollution. Air pollution damages
not only our physical health, but also our economic wellbeing. We
need further research into the economic impact of air pollution, and
the potential economic benefits of well-designed policies to tackle it.

23. 11.Quantify the relationship between indoor air pollution and health.
We must strengthen our understanding of the relationship between
indoor air pollution and health, including the key risk factors and
effects of poor air quality in our homes, schools and workplaces. A
coordinated effort among policymaking bodies will be required to
develop and apply any necessary policy changes

24. 12. Determine how global trends are affecting air quality. From
increased energy production and consumption to global economic
development and urbanisation, we need to improve our
understanding of how major social and economic trends are
affecting air quality and its twin threat, climate change.

25. 13.Develop new technologies to improve air pollution monitoring. We
need better, more accurate and wider-ranging monitoring programmes
so that we can track population-level exposure to air pollution. We also
need to develop adaptable monitoring techniques to measure emerging
new pollutants, and known pollutants that occur below current
concentration limits. We must develop practical technology – such as
wearable ‘smart’ monitors – that empower individuals to check their
exposure and take action to protect their health.

26. The Clean Air Act of 1956

27. 14.Study the effects of air pollution on health. To appreciate fully the risk
to health, we need further research on air pollution’s effects on the body.
In addition to lung and cardiovascular disease, research into the adverse
health effects of pollution should accommodate systemic effects such as
obesity, diabetes, changes linked to dementia, and cancer, as well
as effects on the developing fetus and in early childhood.
Magnetite pollution nanoparticles in the human brain.
Maher BA et al. Proc Natl Acad Sci U S A. 2016 Sep 6. pii:
201605941. [Epub ahead of print]
Those magnetite pollutant particles which are <∼200 nm in diameter
can enter the brain directly via the olfactory bulb. Their presence
proves that externally sourced iron-bearing nanoparticles, rather than
their soluble compounds, can be transported directly into the brain,
where they may pose hazard to human health.

28. Sadiq Khan unveils action plan to battle
London’s toxic air
05 July 2016
 Extending the Ultra-Low Emission Zone (ULEZ) to the North Circular Road and
the South Circular Road and the possibility of bringing forward the
introduction earlier than 2020. Under current plans the ULEZ will only operate
within the Congestion Charging Zone and it is due to come in from 2020.
 Implementing an extra charge on the most polluting vehicles entering central
London using the Congestion Charge payment and enforcement system from
2017 (this would not mean an increase in the Congestion Charge but just the
method for collecting the extra charge from people driving the most polluting
vehicles).
 Introducing ULEZ standards for heavy vehicles London-wide from 2020.
 Giving the go-ahead for Transport for London (TfL) to start work on the costs
and challenges of implementing a diesel scrappage scheme as part of a wider
national scheme delivered by the Government.
Proposals to work with the Government to tackle air pollution on a
national and international level.

29. In a further bid to tackle air quality in the capital, the Mayor has also joined a
High Court challenge of the Government’s air pollution plans as an
Interested Party. Environmental lawyers ClientEarth are suing the
Government for the second time in a year, having won a case at the
Supreme Court in 2015 which ordered ministers to fulfil their legal duty to cut
pollution in “the shortest time possible”. The new case argues the
government is still failing to do this.
The Mayor has now set out his view that London can meet the legal
standards for NO2 well before 2025, which is the date the Government’s
Air Quality Action Plan projects London will be compliant.
Next steps: inform and empower the public on the serious
effects of air pollution and lobby MPs for change as was so
successful in Clean Air Acts of 1956 and 1968 and more recently, the
delivery of tobacco legislation